Cardiovascular Event Risks Associated With Masked Nocturnal Hypertension Defined by Home Blood Pressure Monitoring in the J-HOP Nocturnal Blood Pressure Study
Abstract
There is no information regarding the potential association between cardiovascular disease (CVD) event risks and masked nocturnal hypertension defined by home blood pressure (BP) monitoring. We sought to examine this association in a general practice population. For this purpose, we used data from the J-HOP (Japan Morning Surge-Home Blood Pressure) Nocturnal BP Study, which recruited 2745 high-cardiovascular-risk participants (mean [SD] age, 63.6 [10.4] years; 48.7% men; 82.7% on antihypertensive medications). Nocturnal home BPs (HBPs) were measured at 2:00, 3:00, and 4:00 AM using a validated, automated HBP device for 14 consecutive days. The average (SD) of nocturnal HBP measures was 17.1 (13.5). The percentages of participants with controlled BP (nocturnal HBP <120/70 mm Hg and average morning and evening BP <135/85 mm Hg), daytime hypertension (nocturnal HBP <120/70 mm Hg and average morning and evening BP ≥135/85 mm Hg), masked nocturnal hypertension (nocturnal HBP ≥120/70 mm Hg and average morning and evening BP <135/85 mm Hg), and sustained hypertension (nocturnal HBP ≥120/70 mm Hg and average morning and evening BP ≥135/85 mm Hg) were 31.7%, 7.9%, 26.7%, and 33.7%, respectively. During a median 7.6-year follow-up (19 519 person-years), 162 CVD events occurred. The cumulative incidence of CVD events was higher in those with masked nocturnal hypertension and sustained hypertension than in the controlled BP group. Results from Cox models suggested that masked nocturnal hypertension (adjusted hazard ratio, 1.57 [95% CI, 1.00–2.46]) and sustained hypertension (adjusted hazard ratio, 1.97 [95% CI, 1.26–3.06]) were associated with increased risk of CVD events. Participants with masked nocturnal hypertension defined by HBP monitoring are at high risk of future CVD events.
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Nocturnal BP assessed by ABPM has superior prognostic ability compared with OBP and daytime ambulatory or home BP measurements.
“There is evidence that nocturnal BP assessed by ABPM has superior prognostic ability compared with OBP and daytime ambulatory or home BP measurements [221,222].”
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Self-citationKario, K., Kanegae, H., Tomitani, N., Okawara, Y., Fujiwara, T., Yano, Y., Hoshide, S., & on behalf of the J-HOP Study Group (2019) · Hypertension · doi:10.1161/hypertensionaha.118.12740 · Cited by 167 · see citing works
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“HBPM is available to solve these limitations of ABPM.(11,12) In recent years, automated HBPM devices have been developed for the measurement of nocturnal HBP,(13) and a recent metaanalysis showed that the clinical significance of nocturnal BP measured by HBPM is comparable to that of nocturnal BP measured by ABPM.”
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Mancia, G., Kreutz, R., Brunström, M., Burnier, M., Grassi, G., Januszewicz, A., Muiesan, M. L., Tsioufis, K., Agabiti-Rosei, E., Algharably, E. A. E., et al. (2023) · Journal of Hypertension · doi:10.1097/hjh.0000000000003480 · Cited by 3,473 · see citing works
Parati, G., Stergiou, G. S., Bilo, G., Kollias, A., Pengo, M., Ochoa, J. E., Agarwal, R., Asayama, K., Asmar, R., Burnier, M., et al. (2021) · Journal of Hypertension · doi:10.1097/hjh.0000000000002922 · Cited by 178 · see citing works
Self-citationOgoyama, Y., Tada, K., Abe, M., Nanto, S., Shibata, H., Mukoyama, M., Kai, H., Arima, H., & Kario, K. (2022) · Hypertension Research · doi:10.1038/s41440-021-00761-8 · Cited by 59 · see citing works
Self-citationLatest hypertension research to inform clinical practice in Asia
Kario, K., Mogi, M., & Hoshide, S. (2022) · Hypertension Research · doi:10.1038/s41440-022-00874-8 · Cited by 32 · see citing works
Self-citationKario, K., Tomitani, N., Wang, T.-D., Park, S., Li, Y., Shin, J., Tsoi, K., Chen, C.-H., Cheng, H.-M., Siddique, S., et al. (2023) · Hypertension Research · doi:10.1038/s41440-023-01397-6 · Cited by 40 · see citing works
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- Authors
- Fujiwara, T., Hoshide, S., Kanegae, H., & Kario, K.
- Affiliations
- Jichi Medical University (JP)
- Venue
- Hypertension
- Published
- 2020-07
- Volume
- 76
- Issue
- 1
- Pages
- 259-266
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- OpenAlex
- W3033494509
- Cited by
- 93
- References
- 9
- Citations by year
- 2026: 10 · 2025: 22 · 2024: 14 · 2023: 18 · 2022: 17 · 2021: 9 · 2020: 3
- FWCI
- 7.36
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Keywords
- home blood pressure monitoring, cardiovascular events, sustained hypertension, cardiovascular risk, antihypertensive drugs, hypertension control, general practice population, automated blood pressure devices
- MeSH terms
- Heart Disease Risk Factors, Aged, Antihypertensive Agents, Blood Glucose, Cardiovascular Diseases, Circadian Rhythm, Female, Follow-Up Studies, Humans, Japan, Lipids, Male, Middle Aged, Incidence, Proportional Hazards Models, Blood Pressure Monitoring, Ambulatory, Masked Hypertension
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